What is it?
Traumatic brain injury (TBI) is a diagnosis with compounding issues for our military and combat veterans. Referenced as the “signature injury” of the Iraq and Afghanistan conflicts, it has been the focus of many studies and discussions.
TBI causes a change in consciousness that can turn into difficulties in all areas of life thereafter; work, family life, and even reintegration back into civilian society. A change in consciousness, also called an ‘altered state of mind’, refers to any differences in your thought processes or a mental state that is out of the ordinary.
Up until recently, TBI was not well understood. Physical ailments were treated, but mild TBIs were largely left untreated. This caused many veterans to suffer in silence with mood disorders, disrupted sleep, failing memories, and cognitive disfunction.
Even with the studies that the US Department of Veteran’s Affairs has initiated, diagnosis and treatment remain elusive for many veterans. A study published in the US National Library of Medicine states that:
“Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease.”
TBI in soldiers resulting in casualties has almost doubled in Iraq and Afghanistan in comparison to the Vietnam War – from 12% to 22% in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), (US Department of Veteran Affairs, 2018). This is an issue that needs our immediate attention.
In the Media
With increased concern over TBI, government entities have taken up the mantle in trying to raise awareness. The US Department of Defense has made March Brain Injury Awareness Month. They have gathered stories, blog posts, treatment options, and preventative measures as resources for those interested. They have even created a hashtag - #TBIChampion – where people can share their stories through social media.
TBI has garnered a lot of media attention recently. This is especially true in the sports world. Though sports related TBI is not directly related to our veterans, it has opened up a larger discussion about how to prevent it.
You may remember the movie Concussion, starring Will Smith. In the movie, Will Smith’s character (Bennet Omalu) conducts an autopsy on former NFL football player Mike Webster. He discovers neurological deterioration that is similar to Alzheimer's disease. This deterioration was the result of sports-related head trauma. 87 out of 91 former NFL players that have been tested were found positive for some kind of brain disease (Frontline, 2015)
With all the spotlight on sports related TBI, it helps advance the field, which gives us hope that better treatments are on the horizon. These stories also help us understand how TBI effects our veterans, and what they will struggle with as they years go by.
TBI and Veteran Suicide
80% of veterans that have suffered a TBI also have comorbid psychiatric diagnoses – such as PTSD, anxiety, depression, and suicidal ideation. This is much higher in those with polytrauma. The prevalence of multiple traumas increases complications drastically. Nearly half report PTSD, and an additional third have depression with suicidal ideation, according to a study published by the NIH.
These comorbid conditions are highly associated with polytrauma. Around 20% of veterans have sustained some sort of TBI, with the majority of them being in the Army (Brainline, 2019). Around half of these servicemen or women have been the victim of polytrauma, or multiple brain injuries (US National Library of Medicine, 2018).
According to a new study published by the VA, veterans with two of more TBIs – in comparison to vets with one TBI, or none – are twice as likely to consider suicide as an option. The study was the result of interviews with 800 OIF and OEF veterans who held combat roles while overseas. They used the Beck Scale of Suicidal Ideation to determine whether a veteran was deemed to have suicidal thoughts. This falls in line with other studies that have made the connection between TBI and suicidal ideation in the past.
A study published in the Journal of the International Neuropsychological Society quotes a possible reason why TBI may be correlated with suicidal ideation, and it has to do with cognitive functioning:
“Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and suicidal ideation in Veterans with multiple TBIs.”
We’ve also found that TBI is associated with trouble sleeping, and trouble sleeping after deployment is positively correlated with higher risk of suicide. The 2015 Department of Defense study found that 33% of service members reported feeling fatigued more than 3 times a week due to lack of sleep, while 51% reported some sort of sleep-related impact on their daily responsibilities, and this often “follows a chronic course” after deployment. 72% of soldiers who return home are getting less than 6 hours of sleep a night, with many reporting that this lack of sleep effects their relationships and job performance.
“In peace and war, the lack of sleep works like termites in a house: below the surface, gnawing quietly and unseen to produce gradual weakening which can lead to sudden and unexpected collapse.” Says Major General Aubrey Newman (Follow Me, 1981, p. 279).
These are jarring statistic. At the moment, treatment for suicidal ideation is offered at the point where veterans are already considering it, which makes them extremely high risk. With this data, we can identify high-risk veterans before it gets to that point.
Treatment of TBI is individualized, just like getting a diagnosis. Sometimes, TBI is mistaken for other conditions and diagnosis can sometimes be delayed for years. For those who suffer from mild TBI, time and rest can be the best medicine. For moderate to severe cases, treating symptoms is the main plan of attack.
Therapy for dealing with stressful or frustrating symptoms of TBI, like difficulty with cognitive function or impairment in memory, is one of the main prongs of treatment. Medication can also be prescribed. The most common types of medications prescribed are anti-convulsants, anti-depressants, and pain management medications. Many people are critical of the amount of prescriptions used when a veteran reaches out for help. Ten, sometimes twenty, medications can be used to assuage the complications for TBI. We are finding that there are complimentary treatments that can decrease the dependency on pharmaceuticals.
Service Dogs and TBI
K9s For Warriors provides trained service dogs for veterans suffering from TBI. The dogs help with a myriad of psychological issues related to their medical condition. K9s For Warriors’ dogs are handpicked for breed, temperament, and size so they can be an effective ‘brace’ for veterans who need help with limited mobility or dexterity. Because TBI is so often paired with PTSD, anxiety, and depression, the support these dogs give is invaluable to the effort in stopping veteran suicide. TBI and PTSD often coexist, as TBI usually occurs within a traumatic event like the detonation of an IED, mine, or after a military assault. The development of PTSD is now being attributed largely to the stress factors surrounding TBI, not to neurological insult or disfunction like was previously suggested. This leads us to believe that addressing these stressors after TBI is of paramount importance and is one of the things that service dogs do extraordinarily well.
With such a rise in TBIs post 9/11, it’s a chief concern of ours that it is addressed correctly and that all methods of treatment are readily available. Individualized care is the road to successful integration back into civilian society.
Our program has been 99% effective in preventing suicide in the warriors who graduate – and there are more than 500 at this moment in time! A recent study done by Dr. Maggie O’Haire at Purdue University shows that service dogs help alleviate stressors and symptoms caused by these conditions. We hope to see more studies in the future, which will help us make service dogs available to any vet that wrestles with TBI, PTSD, or MST.
More studies are needed to help us find the best possible treatment of TBI. The VA has done a few studies on the subject, but they readily admit that more needs to be done:
“One or two studies does not tell the whole story,” he [Dr. Shura, a neurologist at a VA medical center in North Carolina] says. “Accumulating research from a variety of samples and methodologies is necessary to even begin to understand some of the complex relationships of this topic.”
We support and hope to continue contributing research of our own, as well.